Sentinel lymph node status affects long-term survival in patients with intermediate-thickness melanoma.

OBJECTIVE: The aim of this study was to examine the role of sentinel lymph node biopsy (SLNB) on long-term disease outcome in patients with intermediate-thickness primary cutaneous melanomas. MATERIALS AND METHODS: Forty patients with intermediate-thickness melanomas, defined as 1.0-4.0 mm, underwent SLNB between 1998 and 2011. The disease-free survival (DFS), overall survival (OS) and prognostic factors were analyzed. RESULTS: Median age was 53 years (range: 24-74 years). Median Breslow thickness was 2.8 mm (range: 1.0-4.0 mm) and 27.5% were ulcerated melanomas. Median follow-up time was 70 months (range: 23-168 months). The number of patients with sentinel lymph node (SLN)-positive was 9 (22.5%) and completion lymph node dissection was performed in all of these patients. Ten patients (25%) developed distant and locoregional recurrence; 4 in the SLN-positive group (4/9; 45%) and 6 in the SLN-negative group (6/31; 19%), P < 0.042. In the SLN-negative group, one patient developed regional node recurrence; false-negative rate was 10%. SLN positivity and ulceration were independent prognostic factors for DFS in multivariate analysis (hazard ratio [HR] of 4.6, and 10.5, respectively; P < 0.011). For OS SLN positivity, ulceration and Breslow thickness were found to be the significant prognostic factors (HR of 5.4, 8.5 and 5.0, respectively; P < 0.024). Ten-year DFS and OS for SLN-negative and SLN-positive patients were 71%, 47% (P < 0.003), and 80%, 55% (P < 0.005), respectively. CONCLUSION: This study shows that survival rates are worse in the SLN-positive patients according to the long-term follow-up data. Ulceration and Breslow thickness also have significant effects on long-term survival in patients with intermediate-thickness primary cutaneous melanomas.

The results of 21-year experience of treating anal squamous cell carcinomas.

OBJECTIVE: Anal squamous cell carcinomas are one of the rare cancer types. Due to the developments in the past 35 years, surgery is no longer the first treatment of choice. The aim of this study was to retrospectively examine the outcomes of 24 patients treated in a single center in the last 21 years in terms of applied treatment, local relapse, distant metastasis, post-treatment complications, and survival. MATERIAL AND METHODS: Data obtained from 24 anal squamous cell carcinoma patients, who were treated in Ankara Oncology Research and Education Hospital between 1990 and 2010, were retrospectively evaluated. RESULTS: Of the 24 patients, 16 had anal canal squamous cell carcinoma and eight had perianal squamous cell carcinoma. All of the patients with anal canal squamous cell carcinoma (n=16) received chemoradiotherapy. Three of these patients who did not respond to treatment, underwent abdominoperineal resection. The patients with perianal squamous cell tumors were treated by local excision. During the follow -ups, seven patients experienced local relapse, and one patient had distant organ metastasis. Only one patient died. Five-year disease free survival rate was found as 66%. CONCLUSION: Our findings suggest that the first alternative in the treatment of anal squamous cell tumors should be chemoradiotherapy; and surgery seems to be the appropriate approach for the non-responsive and relapsing cases.

Prognostic factors affecting locoregional recurrence in patients with stage IIIB noninflammatory breast cancer.

BACKGROUND: The aim of the present study was to identify the clinicopathological factors affecting locoregional recurrence (LRR) in patients with clinical stage IIIB noninflammatory breast cancer (NIBC). METHODS: The records of 120 stage IIIB NIBC patients treated with neoadjuvant chemotherapy (NAC) and then modified radical mastectomy followed by radiotherapy were evaluated. In this retrospective cohort, the effects of age, menopausal status, clinical tumor size, clinical response to NAC, pathological axillary status, number of positive axillary lymph nodes, pathological response to NAC, grade, lymphovascular invasion, estrogen receptor status, progesterone receptor status, Her-2-neu status, and p53 status on LRR were evaluated by univariate and multivariate analyses. RESULTS: The clinical response rate of 120 patients was 79.2% (17.5% complete and 61.7% partial), with a complete pathological response rate of 12.5%. The median follow-up was 28 months (range: 10-74 months). The LRR rate was 13.3%. Based on the univariate analysis, the clinical tumor size, clinical response rate, pathological axillary status, four or more positive axillary lymph nodes, lymphovascular invasion, and estrogen receptor status were factors that significantly affected LRR. In the multivariate analysis, however, only the clinical response rate and the number of positive axillary lymph nodes were found to be statistically significant independent factors. CONCLUSIONS: Effective local control of disease can be achieved in patients with stage IIIB NIBC using a combination of NAC, surgery, and radiotherapy. However, a worse clinical response after chemotherapy and four or more positive axillary lymph nodes affect LRR negatively in these patients.

The correlation of extranodal invasion with other prognostic parameters in lymph node positive breast cancer.

BACKGROUND: The presence of extranodal invasion (ENI) in the metastatic lymph nodes is reported to increase the risk of locoregional recurrence while shortening disease-free and overall survival in patients with breast cancer. In this study the relationship between ENI and other prognostic parameters and survival is investigated. METHODS: Of 650 patients with breast cancer who were treated in Ankara Oncology Teaching and Research Hospital from 1996 to 2003, 368 (56.6%) had lymph node metastasis. The patients with axillary metastasis were separated into two groups as with and without invasion to lymph node capsule and the surrounding adipose tissue. Clinicopathologic features were analyzed by univariate and multivariate logistic regression. RESULTS: Of 368 patients with axillary metastasis, 135 (36.7%) had ENI. Based on multivariate analysis; the number of metastatic lymph nodes, lymphatic invasion, and tumor necrosis were found to be related with ENI. In the group with ENI, 5-year overall survival rate was 74.8%, compared to 82.3% for patients without ENI which was significantly lower (P = 0.04). CONCLUSIONS: In lymph node positive breast cancer with presence of ENI, adverse prognostic parameters are more frequently encountered and has a worse overall survival compared to group without ENI.

D-dimer as a marker for early diagnosis of acute mesenteric ischemia.

INTRODUCTION: Acute obstruction of mesenteric artery generally has an unfavorable prognosis because of late diagnosis. In this study we evaluated the diagnostic value of plasma D-dimer level as an early indicator in acute mesenteric ischemia in rats caused by ligation of superior mesenteric artery. MATERIALS AND METHODS: Twenty-eight mature male Wistar rats were used in the study. These were divided into four groups, each consisting of seven rats. In group I, after performing a simple laparotomy, blood was sampled at minute 30. In group II, first the superior mesenteric artery was ligated, and blood samples were taken at the 30th minute. Group III consisted of rats undergoing a simple laparotomy and blood samples were taken 7 h later. From the subjects in group IV blood samples were obtained 7 h after the ligation of their superior mesenteric artery. RESULTS: Plasma D-dimer levels of the ligated groups were significantly higher both at the 30th minute and the 7th hour compared to the levels of those having undergone simple laparotomies (p<0.002). Likewise, this level was higher in the 7th hour blood samples of the ligated group than in the 30th minute (p<0.008). CONCLUSIONS: In rats undergoing acute mesenteric ischemia by ligation of superior mesenteric artery, plasma D-dimer levels increase with the duration of the intestinal ischemia period. This finding suggests that the measurement of the plasma D-dimer levels might be a useful tool for the early diagnosis of acute mesenteric obstruction.

Detection of infraclavicular lymph node metastases using ultrasonography in breast cancer.

BACKGROUND AND OBJECTIVES: As infraclavicular lymph node metastases is one of the parameters of stage III-C, the diagnostic techniques aiming to identify the metastases of this region have gained importance recently. In this study, we investigated the presence of axillary and infraclavicular lymph node metastases with ultrasonography. METHODS: Axillary and infraclavicular lymph nodes were evaluated by preoperative ultrasonography in 100 consecutive breast cancer patients. Median age was 47 (23-76) years. RESULTS: Ultrasonography identified lymph nodes correlating with metastases in the infraclavicular region in 20 patients. In 19 of these patients, metastases were verified in the lymph nodes with histopathologic examination (false positivity rate 5%). Of the 80 patients who were not considered as having metastases by ultrasonography, 59 had no metastatic lymph nodes on histological examination. The specificity of ultrasonography in the identification of metastatic lymph nodes in the infraclavicular region was 98.3%, with a sensitivity of 47.5%, positive predictive value of 95%, negative predictive value of 73.7%, and overall accuracy of 78%. CONCLUSIONS: Patients who were identified to have infraclavicular lymph node metastases by preoperative ultrasonographic examination should have a relevant treatment plan as they are classified as locally advanced, stage III-C disease.